Chapter 9- Cardiovascular System Flashcards
(132 cards)
1
Q
Occupies the most of the anterior cardiac surface
A
Right Ventricle
2
Q
Lies below the junction of the sternum and the xiphoid process
A
Inferior border of RV
3
Q
structure at the level of the sternal angle or base of the heart
A
Pulmonary artery
4
Q
Forms the lateral left margin of the heart
A
Left ventricle
5
Q
Inferior tip of left ventricle is the
A
Cardiac apex
6
Q
produces the apical impulse
A
Cardiac apex
7
Q
Palpation of the precordium will give you the
A
Point of maximal impulse
8
Q
Location of the PMI
A
Left border of the heart
5th intercostal space
Medial to the left midclavicular line
7-9 cm lateral to the midsternal line
9
Q
PMI is on the right
A
Situs inversus
Dextrocardia
10
Q
In supine patients, diameter of PMI is
A
1 to 2.5 cm
11
Q
PMI is greater than 2.5 cm
A
Left ventricular hypertrophy from hypertension or aortic stenosis
12
Q
Most prominent palpable PMI in person with COPD
A
Xiphoid or epigastric area due to right ventricular hypertrophy
13
Q
If PMI is palpable >10 cm lateral to midsternal line, person has
A
LVH
Ventricular dilatation from myocardial infarction or congestive heart failure
14
Q
Reflects right atrial pressure, which in turn equals central venous pressure and right ventricular end-diastolic pressure
A
Jugular venous Pressure
15
Q
The JVP is best estimated at
A
right internal jugular vein (most direct channel to the superior vena cava and right atrium)
16
Q
Jugular veins and pulsations are difficult to see in?
A
Children under 12 years old
17
Q
pressure where the dominant movement is inward coinciding x descent
A
JVP
18
Q
Pulse where the dominant movement is outward
A
Carotid pulse
19
Q
Fluctuations of the JVP yields clues about
A
Volume status Right and Ventricular Function Patency of tricuspid and pulmonary valves Pressures in the pericardium Arrhythmias
20
Q
In order to estimate the level of JVP, one must learn to find
A
Highest point of oscillation in the internal jugular vein OR
Point above which the external jugular vein collapsed
21
Q
sternal angle is _____ cm above the right midatrium
A
5 cm
22
Q
JVP measured is ELEVATED AND ABNORMAL WHEN?
A
When JVP is measured above >3cm above the sternal angle of > 8 cm above right atrium
23
Q
The usual starting position for the head of the bed or examining table when assessing JVP is
A
30 degrees
24
Q
In hypovolemic patient, JVP will be? Position of the head to see the point of oscillation best?
A
Low (0 degrees)
25
In hypervolemic patients, JVP will be? Position of the head to see the point of oscillation best?
High JVP
| Elevate patient’s head @ 60-90 degrees
26
Interpretation of the measured JVP
JVP at >3 cm above sternal angle or >8cm in total distance above the right atrium is ELEVATED
27
An elevated JVP is highly correlated with?
```
Acute and Chronic Heart Failure
Tricuspid stenosis
Chronic pulmonary hypertension
Superior Vena Cava Obstruction
Cardiac Tamponade
Constrictive Pericarditis
```
28
An elevated JVP is >95% specific for
Increased left ventricular and diastolic pressure
| Low left ventricular EF
29
JVP appear elevated on expiration but veins collapse on inspiration
Obstructive lung disease
30
Pressure in the carotid sinus may cause
Reflex bradycardia
31
Carotid pulse in cardiogenic shock
Small, thready, weak
32
Carotid pulse in aortic regurgitation
Bounding
33
The carotid pulse is delayed in?
Aortic stenosis
34
Thrills in aortic stenosis are transmitted to the carotid arteries from the?
Suprasternal notch or 2nd right intercostal space
35
Bruits are caused by
```
Atherosclerotic luminal stenosis
Turtuous carotid artery
External carotid arterial Disease
Aortic stenosis
Hypervascularity of hyperthyroidism
External compression from thoracic outlet syndrome
```
36
Low-pitched extra sounds such an S3, opening snap indicates
Diastolic rumble of mitral stenosis
37
Soft-decrescendo higher-pitched diastolic murmur indicates
Aortic regurgitation
38
rare congenital transposition of the heart is situated in the right chest cavity and generates a right-sided apical impulse
Dextrocardia
39
The heart, lung, stomach and spleen are on the right, and the liver and gallbladder are on the left
Full situs inversus
40
Most useful characteristic of the apical impulse for identifying hypertrophy of the left ventricle
Duration
41
Shift the apical impulse upward and to the left
Pregnancy or High left diaphragm
42
Lateral displacement toward the the axillary line from ventricular dilatation is seen in?
```
Heart failure
Cardiomyopathy
Ischemic heart disease
Thoracic deformities
Mediastinal shifts
```
43
The apex beat is palpable in 25%-40% of adults in the _____ position
Supine position
44
The apex beat is palpable in 50%-70% of adults in ____ position
Left lateral decubitus position (especially those who are thin)
45
In the left lateral decubitus position, a diffuse PMI with a diameter of >3 cm signals?
Left ventricular enlargement
46
A hyperkinetic high-amplitude impulse may occur in?
Hyperthyroidism
Severe anemia
Pressure overload from left ventricle from hypertension or aortic stenosis
Volume overload of the left ventricle from aortic regurgitation
47
A sustained high amplitude impulse increases the likelihood from
LVH from pressure overload in hypertension
48
If sustained high-amplitude impulse is displaced laterally, it considers
volume overload
49
Valves open during systole
Aortic and pulmonic valve
50
Valves open during diastole
mitral and tricuspid valves
51
Atypical descriptors of chest pain is common in
women and elderly
52
Acute aortic dissection description
Tearing, ripping or radiating
53
Shortness of breath is produced by
Dyspnea
Orthopenia
PND
54
Anasarca determinant is edema
Above the knee
55
Albumin is filtered out from the glomerulus
Nephrotic Syndrome
56
Most common cause of fainting
Neurocardiogenic
57
Cardiologist commonly used in assessment
10 year cardiovascular risk
58
Diabetes risk assessment is done
Every 3 years
59
Lifestyle modification normal daily sodium intake:
Less than 6 grams
60
Blood pressure elevated at values in mmHg:
120/80-129/89
61
Hypertension causing left ventricular hypertrophy is due to:
Due to high pressure in aorta
62
Normal PMI
<2.5 cm in diameter
63
Abnormal diameter of PMI is attributable to:
Aortic Stenosis
| Hypertension
64
Hypovolemic patients are best positioned at, when taking JVP
30 degrees
65
Difference between carotid pulse and internal jugular pulsation
b. IJV is biphasic, carotid is single pulse c.IJV affected by inspiration, carotid is not
d. IJV change by position, carotid is not
66
Positioning for carotid pulse palpation
Supine head elevated
67
Palpate at level of cricoid not thyroid cartilage, why?
To prevent vasovagal stimulation
68
Pulsus alternans is indicative of:
Left ventricular dysfunction
69
Paradoxical pulse is indicative of:
Cardiac tamponade
70
Instruction to clearly heard bruit in carotid artery
Position with head leaning forward
71
Positioning for aortic regurgitation suspicion:
Orthopneic position
72
Carotid upstroke coincide with what heart sounds?
S1
73
OS extra sound is indicative of:
Mitral stenosis
74
Splitting of heart sound
S2
Aortic then Pulmonic
Inspiration
75
Diaphragm of the stethoscope is used in the following
S1 and S2 high pitch sound
b. Murmurs AR and MR
c. Peicardial friction rub
76
Bell is used in the following
Low pitch
Murmur of MS
Apply lightly
77
50-year-old male, chronic uncontrolled hypertension. BP 160/100 mmHg, HR 80 bpm. PE reveals PMI 3cm at 6th left intercostal space at anterior axillary line.
Left ventricular hypertrophy
78
cause leftward deviation of PMI.
LVH
MI
CHF
79
In recent studies, what heart sound may arise from rapid deceleration of the column of blood against the ventricular wall?
S3
80
What does S2 mean?
c. The nadir of the closing of the aortic valve
81
Loud systolic blowing murmur heard at the right parasternal intercostal space radiating to the cardiac apex and left carotid areas.
Mitral regurgitation
82
Recurrent palpitations and easy fatigability. History of tonsillo-pharyngeal infection. Soft diastolic murmur located in cardiac apex.
Mitral stenosis
83
JVP is indicative of
Right atrial pressure
84
Classic exertional chest pain, pressure, or discomfort in the chest, shoulder, back, neck or arm is seen in 18% of patients with:
Acute MI
85
Defines moderate alcohol consumption:
< 2 drinks in male
<1 drink in females
2 drinks= 1 oz ethanol
= 24 oz beer
= 10 oz wine
= 2-3 oz whiskey
86
Physical finding for carotid pulsation and not jugular pulsation.
Single outward movement
87
Which of the following is often preceded by systolic click?
Mitral valve prolapse
88
Best heard with patient leaning forward.
Aortic Regurgitation
89
Increase in systole 10mmhg, during inspiration
Paradoxical pulse
90
Lower extremities PAD risk factors,
A. >/= 65yo
C. Leg symp with exertion
D. Nonhealing wounds
91
Female patient, BMI = 30, BP cuff placed at ankle. Where do you position the stethoscope?
Dorsum of the foot
92
Male, 63, rushed to ER due to stabbing chest pain which radiates to the back (PS 9/10). After doing ECG what is the next best thing to do?
2D echo
93
Intermittent claudication.
Chronic arterial insufficiency
94
Tissue ischemia.
A. Chronic Arterial Insufficiency
95
Edema present, often marked.
Chronic Venous Insufficiency
96
Stasis dermatitis present.
Chronic Venous Insufficiency
97
Gangrene
Chronic Arterial Insufficiency
98
Define AAA
Infrarenal artery < 3cm
99
Strongest risk factor for AAA
Old age
Male
Smoking
100
Patient’s brachial pulse (brisk). How do you interpret this physical
+2
101
COPD patient. Where is the probable location of the PMI?
Xiphoid/Epigastric Area
102
Valve at the Right 2nd interspace to the apex
Aortic Valve
103
Left 2nd and 3rd interspaces close to the sternum
Pulmonic Valve
104
At or near the lower left sternal border:
Tricuspid Valve
105
At or around the cardiac apex
Mitral Valve
106
Follows the AHA criteria
A. Exercise moderate intensity: >=100mins/week
B. BMI: 30kg/m2
C. Fasting blood sugar: <100mg/dl
D. Triglyceride: <250mg/dl
C
107
A patient with Chronic Obstructive Pulmonary Disease who is non-compliant on his maintenance medications came in for his annual check-up. As the medical intern on duty, you were tasked by the Resident Physician to do a thorough physical examination on his cardiovascular system. What is an expected finding for this patient? A. The point of maximal impulse is located on the apex.
The point of maximal impulse may be in xiphoid or epigastric area
108
Condition where S1 is diminished.
First Degree Heart Block
109
```
Female. BMI: 31. Waist circumference: 105cm. Other criteria for metabolic syndrome:
A. Triglyceride <150 mg/dL
B. HDL 30 mg/dL
C. FBS < 100 mg/dL
D. Blood pressure 120/80mmHg
```
B
110
Eggs bacon and sausage:
a.High in cholesterol and saturated fat
111
Decresendo murmur that can be heard at 4th ICS near the sternum that radiates to the apex.
Aortic Regurgitation
112
Grade 5/6 murmur. a.Very loud with thrill.
b.Very loud with thrill, may be heard when the stethoscope is partly off the chest.
113
Pansystolic murmur radiates to axilla.
Mitral regurgitation, anterior leaflet involvement
114
Diagnosis of mitral valve prolapse. What do you say to keep your friend calm?
More common in females than males
115
Diffuse PMI, murmur radiating to axilla.
HF with mitral regurgitation
116
As you were examining a patient with combined aortic stenosis and aortic regurgitation, you noticed an increasing arterial pulse with double systolic peak. Identify this abnormal arterial pulse.
C. Bisfierens pulse
117
Pulmonary hypertension
P2 is equal or louder than A2
118
18 y.o female 3rd year student, BP=110/70 HR = 116, rushed to the ER for palpitations.
A. hyperthyroidism
B. anxiety
C. atrial fibrillation
D. angina pectoris
B
119
True of physiologic S3:
a. common in 1st trimester in pregnancy
b. appreciated in children and adults 45-50
c. heard best in 2nd left IS on inspiration
d. listen with bell, very light light pressure
D
120
```
Which is true?
A. A wave atrial relaxation
B. X wave atrial contraction
C. V wave ventricular systole
D. Y wave ventricular contraction
```
C
121
True of cardiac events
a. During systole aortic valve is open b.During systole mitral valve is open
c. During diastole pulmonic valve is open
d. During diastole mitral valve is close
A
122
Best describes ECG
a. 6 leads frontal plane
b. 5 limb leads
c. Measure pulse pressure
d. Determines hypertension
A
123
```
JNC8 indication >18 with CKD and Diabetes
A. S>/=120 D 90
B. S>/=130 D 90
C. S>/=140 D 90
D. S>/=150 D 90
```
C
124
What is the goal for a woman with central obesity
a.<35 inches
125
Goal of activity according to AHA
a.150 mins/week
126
Liters before occurrence of edema
5 liters
127
Most common extra sound
Systolic click of mitral valve prolapse
128
Expiratory filling suggests
Valvular abnormality
129
Persistent filling results from
Delayed closure of pulmonic valve and early closure of aortic valve
130
Diastolic murmurs usually represents
Valvular Heart Disease
131
The pulse pressure is approximately
30-40 mmHg
132
Increased arterial pulse with double systolic peak
Bisferiens pulse
